Therapy of focal and segmental glomerulosclerosis with methylprednisolone, cyclosporine A, and prednisone

Patients with steroid-resistant focal and segmental glomerulosclerosis (FSGS) have a poor prognosis but may benefit from high-dose methylprednisolone or cyclosporine A therapy. Ten patients were treated with a protocol of methylprednisolone infusions for 8 weeks followed by a combination of cyclospo...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 1998-06, Vol.12 (5), p.397-400
Main Authors: WALDO, F. B, BENFIELD, M. R, KOHAUT, E. C
Format: Article
Language:English
Subjects:
Adolescent
Anti-Inflammatory Agents - administration & dosage
Biological and medical sciences
Biopsy
Child
Child, Preschool
Creatinine
Cyclosporine - administration & dosage
Drug Therapy, Combination
Edema
Female
Glomerulosclerosis, Focal Segmental - drug therapy
Humans
Immunosuppressive Agents - administration & dosage
Infusions, Intravenous
Kidney diseases
Male
Medical sciences
Methylprednisolone - administration & dosage
Patients
Pharmacology. Drug treatments
Prednisone - administration & dosage
Proteins
Remission (Medicine)
Steroids
Treatment Outcome
Urinalysis
Urinary system
Urine
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Summary:Patients with steroid-resistant focal and segmental glomerulosclerosis (FSGS) have a poor prognosis but may benefit from high-dose methylprednisolone or cyclosporine A therapy. Ten patients were treated with a protocol of methylprednisolone infusions for 8 weeks followed by a combination of cyclosporine A and alternate-day prednisone for maintenance of remission for 2 weeks. Eight of ten patients remitted the nephrotic syndrome within 8 weeks of beginning treatment. One patient remitted edema but remained proteinuric, and one did not respond. After observation for 12-24 months, seven patients maintained remission with normal glomerular filtration rate. One non-responder had renal insufficiency and one patient had secondary non-response and end-stage renal disease. No patients developed hypertension. One patient had the diagnosis of Hodgkin disease made after 10 months of therapy. Follow-up renal biopsy in four patients showed no evidence of progressive interstitial disease. There were no other major side effects. Steroid-resistant FSGS may be successfully treated with the described protocol. Additional studies will be needed to determine if this approach prevents progression of renal disease.
ISSN:0931-041X
1432-198X
DOI:10.1007/s004670050473